Postoperative Facial Weakness Research Articles

Feasibility of the preauricular transparotid approach in open reduction and internal fixation of intracapsular mandibular condyle fracture.

Mandibular condyle fractures pose surgical challenges owing to their proximity to the facial nerve and the complex temporomandibular joint anatomy. Traditional approaches limit exposure and hinder effective fracture management. The preauricular transparotid approach is a potential alternative. We aimed to assess the feasibility of this approach and the postoperative complications. A retrospective analysis of 45 patients who underwent open reduction/internal fixation (OR/IF) for intracapsular condylar fractures using a preauricular transparotid approach was conducted. Patient demographics, surgical procedures, radiological assessments, and postoperative complications were analyzed. The preoperative computed tomography analysis revealed the fractured segment's location: 17.0±2.6mm anteriorly, 24.0±4.0mm medially, and 17.8±3.7mm inferiorly from the remaining condyle end. A cubic space of 17-24mm from the condylar stump is necessary to reach the fractured segment end. Postoperative facial nerve weakness occurred in 14 patients but resolved within 4.5 weeks. At 5.5 months of follow-up, the mean interincisional mouth opening measured 40.5±5.1mm, without malocclusion. The approach enhances visualization, facilitates precise fixation, and results in inconspicuous scarring during OR/IF of intracapsular condylar fractures. It requires careful surgical techniques and increases the risk of transient facial nerve weakness. Further research should compare its outcomes with those of traditional approaches and optimize surgical outcomes.

The Outcomes of Superficial Parotidectomy with Intraoperative Facial Nerve Monitoring: Experience in Sawanpracharak Hospital 2020 to 2022

Objective: To determine the outcomes of patients undergone parotidectomy with or without facial nerve monitoring. Materials and Methods: The present study was a retrospective study that included 35 patients underwent superficial parotidectomy with pathologic findings of benign parotid tumor. The patients were divided into two groups. Intraoperative facial nerve monitoring was performed in 15 patients and did not monitor in 20 patients. Data were compared between the surgical groups with intraoperative facial nerve monitoring and the groups without intraoperative facial nerve monitoring using the chi-square test and independent t-test. Results: Patients who underwent parotidectomy between January 1, 2020 and December 31, 2022, whose pathologic findings were benign, a total of 35 cases were divided into 15 patients underwent surgery with intraoperative facial nerve monitoring and 20 patients underwent surgery without intraoperative facial nerve monitoring. There was no statistical difference in operation time and saliva leakage. However, there was a statistical difference in intraoperative blood loss, postoperative facial nerve weakness rate, and postoperative earlobe numbness. Conclusion: The most common complication of parotidectomy is paralysis of the facial nerve. The present study showed that intraoperative facial nerve monitoring can reduce facial nerve paralysis, blood loss during surgery and postoperative earlobe numbness. Keywords: Intraoperative facial nerve monitoring; Parotidectomy; Parotid tumor

A modified method for minimizing damage to the marginal mandibular branch (MMB) during partial superficial parotidectomy(PSP): A retrospective study

The aim of this study was to compare modified partial superficial parotidectomy (MPSP) with conventional partial superficial parotidectomy (CPSP) in a retrograde approach, and to determine whether MPSP can reduce the risk of injury to the MMB of the facial nerve and the rate of postoperative facial palsy.Patients with benign parotid gland tumors of the superficial lobe were included retrospectively in two groups: one group was treated with CPSP; the other group was treated with MPSP, in which the MMB was dissected in an anterograde direction or not dissected. The patients’ sex and age, location of tumor, size of tumor (maximum tumor diameter), histopathological distribution, operative time, and incidence of postoperative facial nerve weakness were compared.There was no significant difference in operative time between the two groups (p = 0.913). There was a significant difference (p = 0.008) in postoperative facial nerve weakness, with temporary facial nerve weakness observed in 19 and five patients in the CPSP and MPSP groups, respectively. Furthermore, there was a significant difference (p = 0.009) in MMB weakness, with temporary MMB weakness observed in 15 and three patients in the CPSP and MPSP groups, respectively. There was no significant difference (p = 0.564) in the weakness of other branches between the two groups. All cases of paresis scored ≤3 on the House-Brackmann scale, and all cases of temporary facial nerve weakness resolved within 6 months of surgery. No patient developed permanent paralysis.Within the limitations of the study, it seems that modified partial superficial parotidectomy (MPSP) should be preferred over conventional partial superficial parotidectomy (CPSP) whenever appropriate.

Minimally Invasive Cervical Access in Head and Neck Microvascular Surgery

Free flap reconstruction often involves extensive cervical access for microvascular anastomosis where management of pathology would otherwise not require cervical approach. This study reports a minimally invasive alternative technique. Investigators designed a prospective case series with subjects who underwent microvascular reconstruction between 2015 and 2020, using a small 2cm incision for vessel access, just below the mandible where facial artery/vein cross. Study variables were subject demographic characteristics, type and location of pathology/defect, and free flap types. Outcomes examined were flap success, postoperative facial weakness using House-Brackmann scale, and esthetic result with Visual Analog Scale. Descriptive statistics computed for study variables. Study sample was 43 subjects, mean age of 48years with 20 males and 23 females. There were a total of 43 flaps with 100% success using our technique. One subject had House-Brackmann level 2 postoperative facial weakness that resolved within 1week. Mean Visual Analog Scale score for scar satisfaction was 9.23/10, standard deviation 0.83. This minimally invasive approach represents an alternative to extensive open cervical access for microvascular anastomosis, offering minimal morbidity and excellent esthetic results.

Deep Lobe Parotid Tumors: A Systematic Review and Meta-analysis.

We performed a systematic review and meta-analysis of deep lobe parotid tumors to evaluate their unique characteristics. PubMed/Medline, Embase, Web of Sciences, and Cochrane Library databases were queried for relevant literature. Studies were individually assessed by 2 independent reviewers. Risk of bias was assessed with the Cochrane bias tool, GRADE criteria, and MINORS criteria. Results were reported according to the PRISMA guidelines. Statistical analysis was performed by comparing rates of malignancy between deep and superficial lobe tumors. In total, 8 studies including 379 deep lobe parotid tumors met inclusion criteria. Mean age at diagnosis was 44.9 years. Computed tomography scan was the most common imaging modality. Preoperative diagnostic fine-needle aspiration was utilized in 39.4% of patients and demonstrated high sensitivity for malignant disease. The most common approach was subtotal parotidectomy with facial nerve preservation (58.9%). The rate of malignancy was 26.6%, which was significantly higher than that of the superficial lobe tumors in this study (risk ratio, 1.25; 95% CI, 1.01-1.56). The rate of temporary postoperative facial nerve weakness between deep and superficial lobe tumors was 32.5% and 11.7%, respectively. Deep lobe parotid tumors had a 26.6% rate of malignancy. On meta-analysis, deep lobe tumors appeared to have higher rates of malignancy than superficial lobe tumors. Surgical excision of deep lobe tumors showed increased rates of temporary facial nerve paresis as compared with superficial lobe tumors. Computed tomography scan was the most common imaging modality. There were limited data regarding the utility of fine-needle aspiration.

Postoperative facial palsy after pediatric posterior fossa tumor resection.

Facial palsy can be caused by masses within the posterior fossa and is a known risk of surgery for tumor resection. Although well documented in the adult literature, postoperative facial weakness after posterior fossa tumor resection in pediatric patients has not been well studied. The objective of this work was to determine the incidence of postoperative facial palsy after tumor surgery, and to investigate clinical and radiographic risk factors. A retrospective analysis was conducted at a single large pediatric hospital. Clinical, radiographic, and histological data were examined in children who were surgically treated for posterior fossa tumors between May 1, 1994, and June 1, 2011. The incidence of postoperative facial weakness was documented. A multivariate logistic regression model was used to analyze the predictive ability of clinicoradiological variables for facial weakness. A total of 163 patients were included in this study. The average age at surgery was 7.4 ± 4.7 years, and tumor pathologies included astrocytoma (44%), medulloblastoma (36%), and ependymoma (20%). The lesions of 27 patients (17%) were considered high grade in nature. Thirteen patients (8%) exhibited preoperative symptoms of facial palsy. The overall incidence of postoperative facial palsy was 26% (43 patients), and the incidence of new postoperative facial palsy in patients without preoperative facial weakness was 20% (30 patients). The presence of a preoperative facial palsy had a large and significant effect in univariate analysis (OR 11.82, 95% CI 3.07-45.44, p < 0.01). Multivariate logistic regression identified recurrent operation (OR 4.45, 95% CI 1.49-13.30, p = 0.01) and other preoperative cranial nerve palsy (CNP; OR 3.01, 95% CI 1.24-7.29, p = 0.02) as significant risk factors for postoperative facial weakness. Facial palsy is a risk during surgical resection of posterior fossa brain tumors in the pediatric population. The study results suggest that the incidence of new postoperative facial palsy can be as high as 20%. The presence of preoperative facial palsy, an operation for recurrent tumor, and the presence of other preoperative CNPs were found to be significant risk factors for postoperative facial weakness.

Outcomes and surgical tips in the management of accessory parotid lobe tumours

The tumours of the parotid accessory lobe may present with significant challenges to the clinicians due to their rarity, presenting with diagnostic difficulties as well as difficult decision-making in terms of surgical approach.We retrospectively analysed 8 cases of accessory parotid lobe tumours treated in our unit. The presenting symptom was a mass in all cases present in the peri-parotid region with duration ranging from 6 weeks to 2 years. All cases were investigated with ultrasound-guided fine needle aspiration cytology (FNAC). Various surgical approaches were adopted that included standard cervico-facial (n = 4), trans-oral (n = 3) and cervical (n = 1) incision approach. The rate of early post-operative facial nerve weakness was 37.5% (n = 3). There were no cases of tumour recurrence.Any lump not typical of a parotid lump but close to the parotid region should be treated with a high degree of suspicion to exclude an accessory lobe tumour. A full work up with US-guided FNAC is recommended prior to definitive treatment. Although a standard cervico-facial incision approach is recommended in most cases, other direct approaches may also be considered depending on the location of the tumour. We present our experience of these tumours providing practical tips on diagnosis and surgical management.

Natural History of Facial Weakness Following Surgery of the Cerebellopontine Angle: A Tertiary Care Cohort.

Facial function is a key outcome in surgery of the cerebellopontine angle (CPA). This study describes the natural history of facial weakness after CPA surgery. Retrospective study of two tertiary centers. Patients undergoing surgery for CPA tumors from 2003 to 2017 with preoperatively normal facial function and without subsequent surgical or adjuvant therapy. Serial facial nerve examinations using the House-Brackmann (HB) scale. Of 301 patients examined, 149 (49.5%) had facial weakness postoperatively and 74.5% of these occurred within 24 hours. Of patients with HB-1 function within 24 hours after surgery, 95.3% had HB-1 function and 100% had HB-3 or better function at last follow-up. Of patients with HB-4 or worse function within 24 hours after surgery, 22.6% ultimately achieved HB-1 function and 83.9% ultimately achieved HB-3 or better function. By 180 days postoperatively, 83.7% of patients' facial function had stabilized. At last follow-up, 3.0% of patients had facial function poorer than HB-3, which was associated with subtotal resections (12.9% vs. 4.4% for near total and 0.6% for gross total resections, p = 0.002), aspirin use (10.6% vs. 1.6%, p = 0.001), larger tumors (p < 0.0005), longer surgery (p < 0.002), and immediate versus delayed postoperative facial weakness (p = 0.002). Facial function over time after CPA surgery is presented. While facial function immediately after surgery correlates with future function, delayed weakness or improvement is common. These data inform patient counseling both preceding and following surgery.

Factors associated with facial weakness following surgery for benign parotid disease: a retrospective multicenter study.

ABSTRACTBACKGROUND: Facial nerve weakness is the most common and most concerning complication after parotidectomy. Risk factors for this complication following surgery for benign diseases remain controversial.OBJECTIVE: Review the frequency and prognosis of facial nerve weakness after parotidectomy and analyze potential risk factors.DESIGN: Retrospective review of medical records.SETTINGS: Two tertiary care centers.PATIENTS AND METHODS: We included all parotidectomies performed for benign diseases from January 2006 to December 2018. Details about the development and recovery of postoperative facial weakness were recorded. Patient, disease and surgery-related variables were analyzed using bivariate and multivariate analyses to identify risk factors.MAIN OUTCOME MEASURES: Frequency, recovery rates and risk factors for facial nerve weaknessSAMPLE SIZE: 191 parotidectomies, 183 patients, 61 patients with facial weakness.RESULTS: The frequency of postoperative facial weakness was 31.9% (61/191 parotidectomies). Among patients with temporary weakness, 90% regained normal facial movement within 6 months. Steroid therapy was not associated with a faster recovery. Postoperative weakness was not associated with age, diabetes, smoking, disease location, use of an intraoperative facial nerve monitor or direction of facial nerve dissection. Risk factors for temporary weakness were total parotidectomy and surgical specimens larger than 60 cubic centimeters. Revision surgery was the only identified risk factor for permanent weakness.CONCLUSION: Larger parotid resections increase the risk of temporary facial nerve weakness while permanent weakness is mainly influenced by previous surgeries.LIMITATIONS: Retrospective nature, underpowered sample size, selection bias associated with tertiary care cases.CONFLICT OF INTEREST: None.

Facial nerve monitoring during parotid gland surgery: a systematic review and meta-analysis

Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland surgery among Otolaryngologist-Head and Neck Surgeons continues to be a matter of debate. A systematic review and meta-analysis of the literature was conducted including articles from 1970 to 2019 to try to determine the effectiveness of intraoperative facial nerve monitoring in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without intraoperative facial nerve monitoring. Ten articles met inclusion criteria, with a total of 1069 patients included in the final meta-analysis. The incidence of immediate and permanent postoperative weakness following parotidectomy was significantly lower in the IFNM group compared to the unmonitored group (23.4% vs. 38.4%; p = 0.001) and (5.7% vs. 13.6%; p = 0.001) when all studies were included. However, when we analyze just prospective data, we are not able to find any significant difference. Our study suggests that IFNM may decrease the risk of immediate post-operative and permanent facial nerve weakness in primary parotid gland surgery. However, due to the low evidence level, additional prospective-randomized trials are needed to determine if these results can be translated into improved surgical safety and improved patient satisfaction.

Additional Benefits of Facial Nerve Monitoring during Otologic Surgery.

This study assesses the role of facial nerve monitoring (FNM) for intraoperative decision making during otologic surgery and possible benefits beyond protecting facial nerve integrity. This prospective study examines intraoperative FNM data and structured interviews collected during 52 otologic procedures. Tertiary referral center. Subjects include adults and children undergoing middle ear or mastoid surgery. Data include intraoperative neuromonitoring activity and structured interviews conducted with the operating surgeon immediately following surgery. Facial nerve stimulation was used to confirm the position of the nerve in 42 of 52 surgical procedures. In 26.9% of cases, the patient became "light" and moved under anesthesia, which was predicted by neuromonitoring 71.4% of the time. Through structured interviews, the operating surgeons reported the following. (1) The facial nerve took an unexpected anatomic course in 7.8% of patients and was difficult to identify in 39.2%. (2) The nerve was at increased risk of injury in 66.7% of cases due to chronic disease or previous surgery. (3) Among these high-risk cases, the monitor helped reduce the risk of nerve damage 100% of the time. (4) Neuromonitoring allowed the surgeon to operate faster 86.5% of the time, and (5) FNM allowed the resident to perform more of the operation 68.9% of the time. No patients experienced postoperative facial weakness. Beyond potentially protecting facial nerve integrity, this study identified additional benefits of FNM, including warning of patient movement during anesthesia, confirming facial nerve anatomic location, reducing operative time, and enhancing resident surgical experience.

Incidence of postoperative facial weakness in parotid tumor surgery: a tumor subsite analysis of 794 parotidectomies

BackgroundThe reported incidence of facial weakness immediately after parotid tumor surgery ranges from 14 to 65%. The purpose of this study was to evaluate the incidence of postoperative facial weakness related to parotidectomy with use of preoperative computed tomography (CT), intraoperative facial nerve monitoring, and surgical magnification. Also, we sought to elucidate additional information about risk factors for postoperative facial weakness in parotid tumor surgery, particularly focusing on the tumor subsites.MethodsWe retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009–2016). Patients with pretreatment facial palsy were excluded from the analyses. Tumor subsites were stratified based on their anatomical relations to the facial nerve as superficial, deep, or both. Multivariable logistic regression analyses were conducted to identify risk factors for postoperative facial weakness.ResultsThe overall incidences of temporary and permanent (more than 6 months) facial weakness were 9.2 and 5.2% in our series utilizing preoperative CT, intraoperative facial nerve monitoring, and surgical magnification. Multivariable analysis revealed that old age, malignancy, and recurrent tumors (revision surgery) were common independent risk factors for both temporary and permanent postoperative facial weakness. In addition, tumor subsite (tumors involving superficial and deep lobe) was associated with postoperative facial weakness, but not tumor size. Extent of surgery was strongly correlated with tumor pathology (malignant tumors) and tumor subsite (tumors involving deep lobe).ConclusionAside from risk factors for facial weakness in parotid tumor surgery such as old age, malignant, or recurrent tumors, the location of tumors was found to be related to postoperative facial weakness. This study result may provide background data in a future prospective study and up-to-date information for patient counseling.

Assessment of Intraoperative Nerve Monitoring Parameters Associated With Facial Nerve Outcome in Parotidectomy for Benign Disease

Prior studies suggest that the use of facial nerve monitoring decreases the rate of immediate postoperative facial nerve weakness in parotid surgery, but published data are lacking on normative values for these parameters or cutoff values to prognosticate facial nerve outcomes. To identify intraoperative facial nerve monitoring parameters associated with postoperative weakness and to evaluate cutoff values for these parameters under which normal nerve function is more likely. This retrospective case series of 222 adult patients undergoing parotid surgery for benign disease performed with intraoperative nerve monitoring was conducted at an academic medical institution from September 13, 2004, to October 30, 2014. The data analysis was conducted from May 2018 to January 2019. The main outcome measure was facial nerve weakness. Receiver operating characteristic curves were generated to define optimal cut point to maximize the sensitivity and specificity of the stimulation threshold, mechanical events, and spasm events associated with facial nerve weakness. Of 222 participants, 121 were women and 101 were men, with a mean (SD) age of 51 (16) years. The rate of temporary facial nerve paresis of any nerve branch was 45%, and the rate of permanent paralysis was 1.3%. The mean predissection threshold was 0.22 milliamperes (mA) (range, 0.1-0.6 mA) and the mean postdissection threshold was 0.24 mA (range, 0.08-1.0 mA). The average number of mechanical events was 9 (range, 0-66), and mean number of spontaneous spasm events was 1 (range, 0-12). Both the postdissection threshold (area under the curve [AUC], 0.69; 95% CI, 0.62-0.77) and the number of mechanical events (AUC, 0.58; 95% CI, 0.50-0.66) were associated with early postoperative facial nerve outcome. The number of spasm events was not associated with facial nerve outcome. The optimal cutoff value for the threshold was 0.25 mA, and the optimal cutoff for number of mechanical events was 8. If a threshold of greater than 0.25 mA was paired with more than 8 mechanical events, there was a 77% chance of postoperative nerve weakness. Conversely, if a threshold was 0.25 mA or less and there were 8 mechanical events or less, there was 69% chance of normal postoperative nerve function. No parameters were associated with permanent facial nerve injury. Postdissection threshold and the number of mechanical events are associated with immediate postoperative facial nerve function. Accurate prediction of facial nerve function may provide anticipatory guidance to patients and may provide surgeons with intraoperative feedback allowing adjustment in operative techniques and perioperative management.

Retrograde parotidectomy under local anesthesia for benign, malignant, and inflammatory lesions.

To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC). A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center. Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1-2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free. In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.

Body Mass Index and Parotidectomy Outcomes.

Multiple specialties have demonstrated increased risk of certain postoperative complications in patients with an increased body mass index (BMI). The goal of this study was to understand the outcomes of patients undergoing parotidectomy with an increased BMI and to identify any other patient risk factors for postoperative complications. This study was a retrospective chart review of 432 patients. Patient variables collected included BMI, age, gender, history of diabetes mellitus, type of parotidectomy, and pathology. Outcomes reviewed included facial nerve weakness, hematoma or seroma formation, and wound infection. The results showed that BMI had no statistically significant effect on complications. However, patients undergoing a total parotidectomy, malignant pathology, and patients with a history of diabetes mellitus had significantly more postoperative facial weakness. In conclusion, BMI does not influence postoperative complications in patients undergoing parotidectomy. Patients with diabetes, those undergoing total parotidectomies, and patients with malignant pathology have significantly more facial weakness and should be counseled accordingly.

Clinical outcomes of endoscopic vs retromandibular approach for the treatment of condylar fractures—a randomized clinical trial

Condylar fractures remain the most controversial topic in maxillofacial trauma. Open reduction and internal fixation (ORIF) with use of an extraoral approach has certain benefits over the nonsurgical treatment. Concerns, however, remain about the risk of facial nerve injury, postoperative facial nerve weakness, and facial scarring when operating in this region despite the various extraoral approaches that have been developed. The recently popularized endoscope-assisted open reduction and internal fixation (EAORIF) is claimed to provide better results because it is minimally invasive, provides excellent visibility, and eliminates surgical scarring and the risk of facial nerve injury. This study, therefore, aims to compare the retromandibular (extraoral) approach and EAORIF for the treatment of condylar fractures. A prospective analysis of 32 cases of condylar fractures that reported to the SDM Craniofacial Centre (Dharwad, India) was carried out. Sixteen patients had been treated with the retromandibular (RM) approach, and 16 had undergone EAORIF in the period from 2012-2017. Patients were evaluated for clinical parameters, such as fracture site, displacement, and surgical duration, as well as for functional parameters, such as occlusion, maximum interincisal opening, deviation of mouth on lateral movements, temporomandibular joint (TMJ) pain and clicking, and facial nerve weakness. Statistical significance was elicited with P < .05. The patients subjected to either approach had suffered fractures of the low condylar neck and the subcondyle. Maximum interincisal opening, mandibular deviation, occlusion, and TMJ function at postoperative month 6 were comparable between the groups. Although no permanent facial nerve injury was seen in this study, the incidence of transient facial nerve weakness was higher in the RM group (56.25%) compared with the EAORIF group (6.25%) (P = .036). The surgical time was longer in the EAORIF group (RM: 107+/- 19.7 minutes and EAORIF: 155 +/- 18.2 minutes) (P = .04). The rest of the parameters were comparable between both groups. Although there is consensus on closed reduction in pediatric and adult condylar head fractures, the role of a surgical approach to treatment of displaced condylar neck and subcondylar fractures remains controversial. In our study, both surgical approaches were found to be suitable for the treatment of these fractures.

Expanded transcanal transpromontorial approach to the internal auditory canal: Pilot clinical experience.

The aim of this study was to describe and evaluate the feasibility of an expanded transcanal transpromontorial approach, developed from the exclusive endoscopic transcanal transpromontorial approach. Retrospective case series. Retrospective chart review of 10 patients operated by an expanded transcanal transpromontorial approach in two tertiary referral centers (University Hospital of Modena, Italy and University Hospital of Verona, Italy). Data from charts and video documentation were collected and analyzed. Between April 2015 and January 2016, 10 patients underwent an expanded transcanal transpromontorial approach for vestibular schwannoma Koos stage I or II and were enrolled in the study. The size of the tumors ranged from 7 to 19 mm in maximum diameter. A gross total resection was achieved in all cases. One subject experienced postoperative cerebrospinal fluid otorhinorrhea and three subjects experienced temporary postoperative facial weakness, all of which completely resolved. The mean follow-up was 5 months. The expanded transcanal transpromontorial approach allowed bimanual dissection using a microscopic technique for the treatment of pathologies of the internal auditory canal and cerebellopontine angle. This novel approach resulted in minimal morbidity and comparable facial nerve preservation rates to the traditional approaches to the internal auditory canal. The expanded transpromontorial approach to the internal auditory canal holds promise for addressing pathology in this region of the temporal bone from the external auditory canal. 4. Laryngoscope, 127:2608-2614, 2017.

Thirty-Day Perioperative Outcomes in Pediatric Parotidectomy.

Limited information exists about the short-term morbidity of parotidectomy in children. This information is important when counseling parents and planning treatment for children with parotid masses. To examine 30-day perioperative outcomes after parotidectomy in the pediatric population. A prospective case series of 87 pediatric patients who underwent parotidectomy from January 1, 2008, to June 30, 2015, performed by 2 pediatric head and neck specialists in a tertiary care pediatric hospital. Thirty-day perioperative complications, postoperative facial nerve function, reoperation rates, and readmission rates were the main outcome measures. Secondary outcome measures were operative time and length of stay. Ninety parotidectomies (71 superficial and 19 total) were performed in 87 patients (48 male and 39 female). Mean age at operation was 8.3 years. Eighty-five of the cases (94%) were performed for benign disease. Mean operative time was 4.09 hours (range, 1.58-10.43 hours) and mean length of stay was 2.24 days (range, 0.97-4.33 days). Immediate postoperative facial weakness was observed in 32 cases (36%); 10 of these cases (31%) involved the upper branch and 29 (90%) involved the lower branch. Immediate postoperative paresis occurred more often after total parotidectomy vs superficial parotidectomy (11 of 19 [58%] vs 21 of 71 [30%]; P = .03) but was unrelated to the etiologic cause of the patients' parotid disease. Thirty of 32 cases (94%) of facial nerve weakness were transient, and the mean time to resolution was 61 days. Eleven complications (12%) other than facial nerve weakness occurred during the 30-day postoperative period. Three patients (3%) required a return to the operating room for hematoma or wound dehiscence. One patient (1%) required readmission in the 30-day postoperative period for contralateral parotitis. We observed a low rate of 30-day perioperative complications as a result of superficial or total parotidectomy for pediatric parotid disease. Major adverse events included return to the operating room and 1 wound infection. Only 1 patient required readmission. Transient weakness of the facial nerve is relatively common, observed more often in the lower division, and can be expected to resolve in most patients by an average of 2 months.

Partial Superficial Parotidectomy With Retrograde Dissection of the Facial Nerve for Clinically "Benign" Parotid Tumors.

To review experience with partial superficial parotidectomy (PSP) and retrograde dissection of the facial nerve as a treatment for benign parotid tumors. Retrospective cohort study of all patients presenting with a suspected benign primary parotid tumor undergoing parotid surgery. There were 214 cases retrieved. Postoperative facial nerve weakness occurred in 33% of patients; all were temporary. Increased extent of surgical resection (P < .001), deeper tumors (P = .05), and close tumor proximity to the facial nerve (P = .007) significantly correlated with postoperative facial weakness. The surgical margin was clear in 54%; 31% had capsule exposed in at least 1 point, and 13.5% had tumor at the margin. Cases with close proximity of tumor to facial nerve were more likely to have tumor at the margin (P = .034). Partial superficial parotidectomy with retrograde dissection is a suitable method for benign appearing parotid tumors.

Impact of extent of parotid resection on postoperative wound complications: a prospective study

Background Sialocele and salivary fistula are common complications after parotidectomy. The purpose of the present study was to investigate whether extent of parotidectomy influences the incidence of these complications. Methods We conducted a prospective study of 66 consecutive parotidectomies. Cases undergoing skin or bone resection or flap reconstruction were excluded. Patients were divided into 2 groups based on extent of surgery: group 1 (extracapsular dissection or partial superficial parotidectomy); and group 2 (superficial parotidectomy or more extensive resection). The incidence of postoperative sialocele, salivary fistula, and facial weakness was studied. Results Eleven patients (16.7%) developed a sialocele, and 4 (6.1%) developed a salivary fistula. Group 1 had a significantly higher incidence of wound complications (p = .008), but a significantly lower incidence of facial weakness (p = .004). Conclusion Less extensive parotid resection seems to be associated with a higher incidence of postoperative sialocele and salivary fistula, but is also associated with less postoperative facial nerve dysfunction. © 2014 Wiley Periodicals, Inc. Head Neck 37: 64–68, 2015